Spider angioma: Difference between revisions
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===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
* | *There is no diagnostic criteria for Spider angioma. | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
* | *Spider angioma, when not extensive, can be benign. | ||
* | *When present extensively it could be due to an underlying cause. | ||
*About 33% of the patients with advanced liver cirrhosis have spider angioma<ref name="pmid10423070">{{cite journal| author=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH | display-authors=etal| title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. | journal=Scand J Gastroenterol | year= 1999 | volume= 34 | issue= 5 | pages= 520-3 | pmid=10423070 | doi=10.1080/003655299750026272 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10423070 }}</ref>. | |||
*Alcoholism and higher bilirubin levels were proven to have correlation for development of Spider angiomas<ref name="pmid10423070" />. | |||
*Young females h | |||
:*[symptom 1] | :*[symptom 1] | ||
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*Patients with [disease name] usually appear [general appearance]. | *Patients with [disease name] usually appear [general appearance]. | ||
*Spider angiomas are usually present on face, chest and arms in the distribution of Superior Vena Cava. But unusual presentations | *Spider angiomas are usually present on face, chest and arms in the distribution of Superior Vena Cava. But unusual presentations with Palpebra<ref name="pmid23121469">{{cite journal| author=Yalcin K, Ekin N, Atay A| title=Unusual presentations of spider angiomas. | journal=Liver Int | year= 2013 | volume= 33 | issue= 3 | pages= 487 | pmid=23121469 | doi=10.1111/liv.12009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121469 }}</ref>, Pluera and subpleura<ref name="pmid2290237">{{cite journal| author=Daimaru N, Okamura T, Nagano H, Shigematsu N, Yasunaga C, Sueishi K| title=[Hypoxemia of liver cirrhosis--an autopsy case study]. | journal=Nihon Kyobu Shikkan Gakkai Zasshi | year= 1990 | volume= 28 | issue= 11 | pages= 1504-10 | pmid=2290237 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2290237 }}</ref>, esophaghus <ref name="pmid19863641">{{cite journal| author=Nur FA, Clemente C, Serino G, Salerno F, Spina L, Vecchi M| title=Atypical esophageal vascular lesions observed in liver cirrhosis. | journal=Dis Esophagus | year= 2010 | volume= 23 | issue= 1 | pages= E9-E11 | pmid=19863641 | doi=10.1111/j.1442-2050.2009.01018.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19863641 }}</ref>,and gastrointestinal tracts have been reported. | ||
*Physical examination may be remarkable for: | *Physical examination may be remarkable for: | ||
| Line 121: | Line 119: | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
* | *Laboratory work up for hepatic etiology (Liver function tests, Viral markers), pregnancy (urine pregnancy test), hyperestrogenic etiology (Estrogen and FSH levels) and thyrotoxicosis (T3,T4, and TSH)<ref name="pmid12571391">{{cite journal| author=Khasnis A, Gokula RM| title=Spider nevus. | journal=J Postgrad Med | year= 2002 | volume= 48 | issue= 4 | pages= 307-9 | pmid=12571391 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12571391 }}</ref> should be done. | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
* There are no ECG findings associated with Spider angiomas. | *There are no ECG findings associated with Spider angiomas. | ||
===X-ray=== | ===X-ray=== | ||
* There are no x-ray findings associated with Spider angiomas. | *There are no x-ray findings associated with Spider angiomas. | ||
===Echocardiography or Ultrasound=== | ===Echocardiography or Ultrasound=== | ||
*There are no echocardiography/ultrasound findings associated with Spider angiomas as such. | *There are no echocardiography/ultrasound findings associated with Spider angiomas as such. | ||
*Ultrasound | *Ultrasound has a high positive predictive value in identifying the underlying liver cirrhosis<ref name="pmid15671013">{{cite journal| author=Viganò M, Visentin S, Aghemo A, Rumi MG, Ronchi G| title=US features of liver surface nodularity as a predictor of severe fibrosis in chronic hepatitis C. | journal=Radiology | year= 2005 | volume= 234 | issue= 2 | pages= 641; author reply 641 | pmid=15671013 | doi=10.1148/radiol.2342041267 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15671013 }}</ref>. | ||
*Ultrasound may be useful in identifying underlying ovarian tumors<ref name="pmid20093591">{{cite journal| author=Twickler DM, Moschos E| title=Ultrasound and assessment of ovarian cancer risk. | journal=AJR Am J Roentgenol | year= 2010 | volume= 194 | issue= 2 | pages= 322-9 | pmid=20093591 | doi=10.2214/AJR.09.3562 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20093591 }}</ref>. | |||
===CT scan=== | ===CT scan=== | ||
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*There are no CT scan findings associated with Spider angiomas. | *There are no CT scan findings associated with Spider angiomas. | ||
*CT scan is the most sensitive imaging modality for identifying the underlying liver cirrhosis<ref name="pmid18544944">{{cite journal| author=Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H | display-authors=etal| title=Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study. | journal=Intervirology | year= 2008 | volume= 51 Suppl 1 | issue= | pages= 17-26 | pmid=18544944 | doi=10.1159/000122595 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18544944 }}</ref>. | *CT scan is the most sensitive imaging modality for identifying the underlying liver cirrhosis<ref name="pmid18544944">{{cite journal| author=Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H | display-authors=etal| title=Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study. | journal=Intervirology | year= 2008 | volume= 51 Suppl 1 | issue= | pages= 17-26 | pmid=18544944 | doi=10.1159/000122595 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18544944 }}</ref>. | ||
*Ct scan can reveal underlying ovarian tumors<ref name="pmid12432104">{{cite journal| author=Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST| title=CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. | journal=Radiographics | year= 2002 | volume= 22 | issue= 6 | pages= 1305-25 | pmid=12432104 | doi=10.1148/rg.226025033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432104 }}</ref>. | |||
===MRI=== | ===MRI=== | ||
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===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
* Biopsy may be helpful in the diagnosis of Spider angioma when the presentation isn't classical. Findings diagnostic of spider angioma include Cutaneous arterial net, Central spider arteriole, Subepidermal ampulla , Star shaped arrangement of efferent spider vessels, and Capillaries<ref>Graham-Brown RAC and Sarkany I. The hepatobiliary system and the skin. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, et al. Editors. Fitzpatrick’s Dermatology in General Medicine. McGraw Hill 1999. Pp1972</ref>. | *Biopsy may be helpful in the diagnosis of Spider angioma when the presentation isn't classical. Findings diagnostic of spider angioma include Cutaneous arterial net, Central spider arteriole, Subepidermal ampulla , Star shaped arrangement of efferent spider vessels, and Capillaries<ref>Graham-Brown RAC and Sarkany I. The hepatobiliary system and the skin. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, et al. Editors. Fitzpatrick’s Dermatology in General Medicine. McGraw Hill 1999. Pp1972</ref>. | ||
==Treatment== | ==Treatment== | ||
Revision as of 04:38, 21 September 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
- [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
- In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
- In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
Classification
- [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
- [group1]
- [group2]
- [group3]
- Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
Pathophysiology
- The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Causes
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Differentiating [disease name] from other Diseases
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
- [Differential dx1]
- [Differential dx2]
- [Differential dx3]
Epidemiology and Demographics
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop [disease name].
- [Disease name] is more commonly observed among patients aged [age range] years old.
- [Disease name] is more commonly observed among [elderly patients/young patients/children].
Gender
- There is no documented study showing gender predilection for Spider Angioma in otherwise healthy population.
- However there is an increased incidence in pregnant women, which
Race
- There is no racial predilection for Spider Angiomas, but can have more visibility in light skinned people.
Risk Factors
- Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Natural History, Complications and Prognosis
- The majority of patients with [disease name] remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
Diagnosis
Diagnostic Criteria
- There is no diagnostic criteria for Spider angioma.
History and Symptoms
- Spider angioma, when not extensive, can be benign.
- When present extensively it could be due to an underlying cause.
- About 33% of the patients with advanced liver cirrhosis have spider angioma[1].
- Alcoholism and higher bilirubin levels were proven to have correlation for development of Spider angiomas[1].
- Young females h
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Spider angiomas are usually present on face, chest and arms in the distribution of Superior Vena Cava. But unusual presentations with Palpebra[2], Pluera and subpleura[3], esophaghus [4],and gastrointestinal tracts have been reported.
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- Laboratory work up for hepatic etiology (Liver function tests, Viral markers), pregnancy (urine pregnancy test), hyperestrogenic etiology (Estrogen and FSH levels) and thyrotoxicosis (T3,T4, and TSH)[5] should be done.
Electrocardiogram
- There are no ECG findings associated with Spider angiomas.
X-ray
- There are no x-ray findings associated with Spider angiomas.
Echocardiography or Ultrasound
- There are no echocardiography/ultrasound findings associated with Spider angiomas as such.
- Ultrasound has a high positive predictive value in identifying the underlying liver cirrhosis[6].
- Ultrasound may be useful in identifying underlying ovarian tumors[7].
CT scan
- There are no CT scan findings associated with Spider angiomas.
- CT scan is the most sensitive imaging modality for identifying the underlying liver cirrhosis[8].
- Ct scan can reveal underlying ovarian tumors[9].
MRI
- There are no MRI findings associated with Spider angiomas.
Other Imaging Findings
- There are no other imaging findings associated with Spider angiomas.
Other Diagnostic Studies
- Biopsy may be helpful in the diagnosis of Spider angioma when the presentation isn't classical. Findings diagnostic of spider angioma include Cutaneous arterial net, Central spider arteriole, Subepidermal ampulla , Star shaped arrangement of efferent spider vessels, and Capillaries[10].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
References
- ↑ 1.0 1.1 Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH; et al. (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand J Gastroenterol. 34 (5): 520–3. doi:10.1080/003655299750026272. PMID 10423070.
- ↑ Yalcin K, Ekin N, Atay A (2013). "Unusual presentations of spider angiomas". Liver Int. 33 (3): 487. doi:10.1111/liv.12009. PMID 23121469.
- ↑ Daimaru N, Okamura T, Nagano H, Shigematsu N, Yasunaga C, Sueishi K (1990). "[Hypoxemia of liver cirrhosis--an autopsy case study]". Nihon Kyobu Shikkan Gakkai Zasshi. 28 (11): 1504–10. PMID 2290237.
- ↑ Nur FA, Clemente C, Serino G, Salerno F, Spina L, Vecchi M (2010). "Atypical esophageal vascular lesions observed in liver cirrhosis". Dis Esophagus. 23 (1): E9–E11. doi:10.1111/j.1442-2050.2009.01018.x. PMID 19863641.
- ↑ Khasnis A, Gokula RM (2002). "Spider nevus". J Postgrad Med. 48 (4): 307–9. PMID 12571391.
- ↑ Viganò M, Visentin S, Aghemo A, Rumi MG, Ronchi G (2005). "US features of liver surface nodularity as a predictor of severe fibrosis in chronic hepatitis C." Radiology. 234 (2): 641, author reply 641. doi:10.1148/radiol.2342041267. PMID 15671013.
- ↑ Twickler DM, Moschos E (2010). "Ultrasound and assessment of ovarian cancer risk". AJR Am J Roentgenol. 194 (2): 322–9. doi:10.2214/AJR.09.3562. PMID 20093591.
- ↑ Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H; et al. (2008). "Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study". Intervirology. 51 Suppl 1: 17–26. doi:10.1159/000122595. PMID 18544944.
- ↑ Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST (2002). "CT and MR imaging of ovarian tumors with emphasis on differential diagnosis". Radiographics. 22 (6): 1305–25. doi:10.1148/rg.226025033. PMID 12432104.
- ↑ Graham-Brown RAC and Sarkany I. The hepatobiliary system and the skin. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, et al. Editors. Fitzpatrick’s Dermatology in General Medicine. McGraw Hill 1999. Pp1972